European Journal of Pediatrics

, Volume 177, Issue 6, pp 827–834 | Cite as

Weekly regimen of vitamin D supplementation is more efficacious than stoss regimen for treatment of vitamin D deficiency in children with chronic liver diseases

  • Bikrant Bihari Lal
  • Seema Alam
  • Rajeev Khanna
  • Dinesh Rawat
Original Article


There are no evidence-based recommendations on the ideal dose and regimen for supplementation of vitamin D in children with chronic liver disease (CLD). This study aimed to compare the safety and efficacy of weekly and stoss regimens for treatment of vitamin D deficiency in these children. Children between the ages of 1 to 18 years with CLD and hypovitaminosis D defined by 25-OH vitamin D (25(OH)D) < 30µg/l were included. They were randomized to receive either stoss regimen (600,000 IU on day 1) or weekly (60,000 IU weekly) regimen of vitamin D. The 25(OH)D levels at 3 and 6 months were compared in the two groups. A total of 210 suspected cases of CLD were assessed for eligibility. Of a total of 67 children satisfying the inclusion criteria, 33 and 34 were randomized to receive stoss and weekly regimen, respectively. Final analysis included 28 children in each group. Clinical rickets was seen in 25.4% of children with hypovitaminosis D. The rise in levels of 25(OH)D at 3 months was higher with weekly regimen (34.3 ± 30.7 µg/l) as compared to stoss regimen (17.2 ± 11.5 µg/l) (p = 0.009). Rise at 6 months as compared to baseline was significantly higher with weekly regimen (30.7 ± 24µg/l) as compared to stoss regimen (11 ± 8.4 µg/l) (p < 0.001). Normal levels of 25(OH)D at 6 months were achieved in 24/28 (85.7%) of those receiving weekly regimen and 9/28 (32.1%) of those receiving stoss regimen (p < 0.001). With stoss therapy, 25(OH)D increased at 3 months as compared to baseline but thereafter dropped significantly at 6 months (p = 0.008).

Conclusion: Weekly regimen of vitamin D supplementation is more effective than stoss regimen for treatment of hypovitaminosis D in children with CLD. Once normal levels are achieved, child should be shifted to 60,000 IU per month as maintenance dose.

What is Known:

Vitamin D deficiency is more common and severe in children with chronic liver diseases.

Currently used doses fail to achieve normal vitamin D levels in these children.

What is New?

Weekly regimen of 60,000 IU of vitamin D3 is the most effective regimen for treating vitamin D deficiency in children with CLD.

Children with CLD should further receive maintenance dose of 60,000 IU every month.


Chronic liver disease Stoss regimen Vitamin D deficiency 



AST to platelet ratio index


Bone morphogenetic protein


Chronic liver disease


Matrix metalloproteinases


Pediatric end-stage liver disease




Recommended daily allowance


Vitamin D binding protein


Vitamin D deficiency


Authors’ Contributions

BBL and SA conceptualized and designed the work. BBL collected the data. SA and BBL analysed the data and prepared the first draft. SA, BBL, DR and RK critically reviewed, revised and approved the final version.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval Number: IEC/IRB-F.25/5/75/ILBS/AC/2014/387.

Informed consent

Informed consent was obtained from the parents of all the children included in the study.

Supplementary material

431_2018_3123_MOESM1_ESM.docx (12 kb)
ESM 1 (DOCX 11.6 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Bikrant Bihari Lal
    • 1
  • Seema Alam
    • 1
  • Rajeev Khanna
    • 1
  • Dinesh Rawat
    • 1
  1. 1.Department of Pediatric HepatologyInstitute of Liver and Biliary SciencesNew DelhiIndia

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